Methods: We performed a retrospective chart review of all actively followed liver, kidney and cardiac transplant recipients in a tertiary-care pediatric hospital (1997 to 2015). We included all children ≤18 years who had data available on: (1) pre-transplant hepatitis B immunization status; (2) post-transplant residual hepatitis B serology at 1 year post-transplant.
Results: Of 114 actively followed SOT recipients, 96 children had information on pre-transplant immunization status. Median (range) age at SOT was 3.1 (0.1-18.5) years, and 49 (51%) children had complete hepatitis B immunization (3 or more doses) before transplant. In the post-SOT analysis, we had to exclude 12 patients. At a median of 12 (6.4-21.1) months post-transplant, residual hepatitis B serology was available for 61 of 102 (60%) children who had not received any booster dose since transplant. Of these, 33 (54%) had an anti-HBs titer greater than 10 IU/L. Of 32 children who had complete hepatitis B vaccination pre-transplant, 11 (34.4%) had an anti-HBs titer below 10 IU/L at a median of 12 months post-SOT.
Conclusion: Pediatric SOT candidates are poorly immunized against hepatitis B before transplant. Among those adequately immunized before SOT, seroprotection was low after transplant. Reasons for this may include a non-response to the primary hepatitis B vaccine series, or loss of anti-HBs as a result of immunosuppression. These findings highlight the importance of a systematic approach to immunization both before and after SOT in pediatric patients.
A. Barbaros, None
B. Tapiero, None
C. Buteau, None
F. Alvarez, None
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